Thanks for the comments. I was wondering how long it would be before someone said this! I’m slightly sympathetic to the ‘this is bad for PR’ argument. But two points on that:
this is mostly a question of framing. It’s not ‘poverty is great’ it’s ‘mental health is really bad, even worse than poverty’.
I think there are virtues to honesty. If we self-censor and don’t try to work out how to do the most good just because we think somehow, somewhere, somebody is going to disagree, then we’re almost certainly not going to work out how to do the most good.
More generally, I don’t think your “Extreme poverty is pretty bad and causes mental health problems” version is true. As you can see from this: (http://cep.lse.ac.uk/layard/thriveannex.pdf) there’s only slightly more depression in poor countries in low-income countries (7%) than high-income countries (6.5%). Layard calculates the averages in his book Thrive (p.41). So that undermines the idea that poverty causes mental health issues and removing people from poverty would fix them. Mental health seems to be a problem of being a human anywhere.
I think a more promising argument, which I make in the paper, is that it might just be a lot cheaper to treat mental health in poorer countries. I also take the utilitarian view that misery, not injustice or anything is, just is the problem. There’s some discussion about whether teaching people to be happy is the right long-term solution even in terms of happiness, but that’s an empirical question that needs investigation.
You also seemed to have merged mental health, poverty and failed states. I’m not sure how to respond to that one.
In response to Behind the Beautiful Forever, you might want to check out this paper—Making the Best of a Bad Situation: Satisfaction in the Slums of Calcutta (http://www.jstor.org/stable/27526958?seq=1#page_scan_tab_contents) which shows those in slums “experience a lower sense of life satisfaction than the more affluent groups, but are more satisfied than one might expect”. I’m somewhat disinclined to take anecdotes or stories as serious evidence: they tend to focus on the interesting parts of life, whereas the upshot from the happiness literature I’ve seen in that most people’s lives are, well, pretty ordinary. That is, unless you’ve got a mental health disorder. Then your life sucks.
First of all, let me say that I agree that mental health is very important. But I think you’re approaching this in a culturally insensitive way that excludes the experiences of many people.
“’mental health is really bad, even worse than poverty”
Yeah that’s the type of statement that sounds super cringey (though I assume you mean mental illness, not mental health). When I saw your post, I was like, “Oh I’ll bet anything this is based on his own experiences with depression.” The link to your app confirmed this. While your experience was unfortunate, it can blind you to the reality of other people’s suffering.
I’m very skeptical of the cross-cultural validity of depression diagnosis, particularly when it involves self-reporting.
Violence and disempowerment is not only a problem of failed states—it’s a nearly universal experience for the poor. You might also want to read A Plague of Locusts which describes the everyday violent crime experienced by the poor, even in “middle-income” countries such as Peru, which has one of the highest rates of sexual violence in the world. The book also presents more statistical evidence for how widespread mental health problems are among crime victims in the developing world.
The idea that people in the developing world are mentally unaffected by everything from police abuse to unprosecuted rape and murder (when we know that these are traumatizing to people in the developed world) has unfortunate echoes of old racist stereotypes. Nineteenth century explorers were often surprised to see indigenous people crying: whites had assumed that non-white races were more resilient and less emotional. (Think of the “stoic Native American” stereotype.)
Great point about the cross-cultural validity of depression diagnosis.
For that matter, I’d be awfully concerned about the cross-cultural (or cross-socioeconomic-group!) validity of life-satisfaction measures. Often they are asked something like so:
Please imagine a ladder with steps numbered from zero at the bottom to 10 at the top.
The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.
On which step of the ladder would you say you personally feel you stand at this time? (ladder-present)
On which step do you think you will stand about five years from now? (ladder-future)
There are obvious ways in which this question might cause someone to give, say, their life satisfaction as a percentile compared to people around them, rather than an absolutely comparable number, which would bias it up a lot for poor countries.
I’m not sure what an absolutely comparable number would be: people would have to be comparing themselves to the same unchanging criteria over time. The evidence, from the Easterlin Paradox etc. is that people do change their standards over time and largely seem work out how they are doing my comparing themselves against others. As such it looks like increasingly worldwide life satisfaction would be very hard.
I take these sorts of argument as reasons to move away from life satisfaction towards direct measures of people’s experience in the moment. I want to know how good or bad the person actually feels, not how well they they are doing against an arbitrary and changing standard.
Just a small note: the book you refer to, “A Plague of Locusts”, is actually called “The Locust Effect” (Haugen and Boutros) - took me a while to find it, so figured that others might appreciate the correction :) Thanks for the recommendation.
I don’t think my own experiences are terribly important and I’m much more interested in arguing about the points themselves.
I’m not sure how you can disagree with the statement that mental health disorders are worse than poverty in terms of happiness; that’s true simply in virtue of what they are. Being depressed means you experience lots of negative mental states (i.e. are unhappy). Being poor doesn’t mean that. Actually being unhappy has to be worse than being a state that is likely to make you unhappy.
Putting this the other way round, you could say “depression is bad for your income, but being in poverty is worse”. Depression might cause you to earn less, but if you’re looking at income, then the state of having a low income has to be worse than having something liable to cause you to have low income. It’s also not true that all people in poverty are depressed. So I think it makes more sense to target misery, not poverty.
Do you think I’ve misunderstood your point? Sorry if I have.
I’m also very much in favour in targeting violence, crime, etc. as those seem obviously bad for happiness. However I’m not sure how bad, nor do I have a potential solution. On that note, the problem of adaptive preferences, as discussed by Sen, etc. is quite interesting. He argues that the poor adapt to their terrible condition and thus they seem surprisingly happy—they are making the best of a bad lot—and that is an additional reason to do something.
I take the other line: if I could save person X who will be made happier, or person Y who won’t be because person Y will adapt to the new condition, I’d want to treat X, not Y.
I feel like this is a motte-bailey argument. Sure, in some trivial sense “depression” is what everyone cares about, in that everyone wants to prevent suffering. A chicken on a factory farm is “depressed”. An acid attack victim is “depressed”. But it seems like when you say depression, what you really mean is “feelings of lethargy, apathy, and discouragement that afflict many people (particularly Westerners) at some point during their lives”—this is what most people understand depression to mean. It’s certainly arguable whether this is worse than many other forms of suffering, and it feels a bit arrogant to glibly dismiss other experiences.
Furthermore, you continue to use “mental health disorder” as synonymous with “depression”. As I asked before, where’s your solution for schizophrenia?
I’m not sure how you’ve reached your conclusion on the basis of what I’ve said. I’m taking ‘depression’ to be a mental health disorder with certain symptoms, including substantially lowered mood. I’m not using ‘depression’ as a synonym for ‘feeling a bit bad’.
I’m making the claim that depression, which is constituted by lots of negative emotional states (i.e. states that feel bad to the person) is probably worse that many, if not all, other forms of suffering in terms of happiness (your ‘happiness’ = the sum total of momentary positive mental states less your negative ones). In part this is because depression induces intense negative states, in part because we don’t seem to be able to hedonically adapt to the condition in a way we can to, say, becoming paraplegic.
I’m not glibly dismissing other cases of suffering. I think you seem to be objecting to doing all things considered evaluations of how bad various things are. If you don’t want to do all things considered evaluations it’s quite hard, if not impossible, to make important moral choices.
Depression is just one of a range of mental health disorders, that’s true. Where I’ve used them synonymously that was simply careless and definitely my mistake.
And I don’t have solution for schizophrenia, nor did I realise I was supposed to! I’m a philosopher who researches happiness, not a psychiatrist.
I think the claim that depression “is probably worse that many, if not all, other forms of suffering in terms of happiness” is far too strong and you haven’t provided sufficient evidence for it. As you said, you’re not a psychiatrist, and I think you’re relying too much on a priori (and somewhat tautological) reasoning, evidence from self-reporting of questionable validity, and outdated research on adaptation (see the meta-analysis that I linked in another comment). There’s a case to be made for your position, but it needs to be strengthened to justify your sweeping statements.
The reason I brought up schizophrenia is because it felt like you were moving the goalposts, not because I expected you to have a solution. You brought up aggregate mental illness statistics but then only discussed depression. But thank you for admitting the mistake.
Just to add to this. Acute schizophrenia is one of the worst health conditions on GBD13 DALY weightings (c.0.8). Severe depression is also one of the worst (c.0.65).
So Michael—I agree it’s very possible that mental health disorders are underweighted by DALY weightings because of the focusing illusion. But they are actually weighted quite highly at the moment. 10 years with severe depression is worth approximately 3.5 years of healthy life.
yes, it’s interesting that schizophrenia tops the list anyway, although this could be the case in virtue of the face it stops you from leading a normal life part of the disability (this being based on the EQ-5D), rather than because severe schiozophrenics are less happy than severely depressed people.
although they are weighted highly, that doesn’t stop them from being underweighted. Given the way DALYs are constructed—measuring health, not happiness; using preferences, not adaptation—it’s conceptually very hard to see how mental health conditions can’t be underweighted in terms of happiness. Unless and until we measure people’s experiences of various diseases we really won’t know.
My guess is that depression could be the most comparatively underweighted health state: if you can function normally, but you’re just really sad, you might do pretty well on an EQ-5D metric because you’re only doing badly in 1 of 5 criteria, and that’s the criteria most linked to happiness.
As an aside, do you know how the GBD project takes episode duration into account? Or is it just a measure of intensity?
Thanks for the comments. I was wondering how long it would be before someone said this! I’m slightly sympathetic to the ‘this is bad for PR’ argument. But two points on that:
this is mostly a question of framing. It’s not ‘poverty is great’ it’s ‘mental health is really bad, even worse than poverty’.
I think there are virtues to honesty. If we self-censor and don’t try to work out how to do the most good just because we think somehow, somewhere, somebody is going to disagree, then we’re almost certainly not going to work out how to do the most good.
More generally, I don’t think your “Extreme poverty is pretty bad and causes mental health problems” version is true. As you can see from this: (http://cep.lse.ac.uk/layard/thriveannex.pdf) there’s only slightly more depression in poor countries in low-income countries (7%) than high-income countries (6.5%). Layard calculates the averages in his book Thrive (p.41). So that undermines the idea that poverty causes mental health issues and removing people from poverty would fix them. Mental health seems to be a problem of being a human anywhere.
I think a more promising argument, which I make in the paper, is that it might just be a lot cheaper to treat mental health in poorer countries. I also take the utilitarian view that misery, not injustice or anything is, just is the problem. There’s some discussion about whether teaching people to be happy is the right long-term solution even in terms of happiness, but that’s an empirical question that needs investigation.
You also seemed to have merged mental health, poverty and failed states. I’m not sure how to respond to that one.
In response to Behind the Beautiful Forever, you might want to check out this paper—Making the Best of a Bad Situation: Satisfaction in the Slums of Calcutta (http://www.jstor.org/stable/27526958?seq=1#page_scan_tab_contents) which shows those in slums “experience a lower sense of life satisfaction than the more affluent groups, but are more satisfied than one might expect”. I’m somewhat disinclined to take anecdotes or stories as serious evidence: they tend to focus on the interesting parts of life, whereas the upshot from the happiness literature I’ve seen in that most people’s lives are, well, pretty ordinary. That is, unless you’ve got a mental health disorder. Then your life sucks.
First of all, let me say that I agree that mental health is very important. But I think you’re approaching this in a culturally insensitive way that excludes the experiences of many people.
“’mental health is really bad, even worse than poverty” Yeah that’s the type of statement that sounds super cringey (though I assume you mean mental illness, not mental health). When I saw your post, I was like, “Oh I’ll bet anything this is based on his own experiences with depression.” The link to your app confirmed this. While your experience was unfortunate, it can blind you to the reality of other people’s suffering.
I’m very skeptical of the cross-cultural validity of depression diagnosis, particularly when it involves self-reporting.
Violence and disempowerment is not only a problem of failed states—it’s a nearly universal experience for the poor. You might also want to read A Plague of Locusts which describes the everyday violent crime experienced by the poor, even in “middle-income” countries such as Peru, which has one of the highest rates of sexual violence in the world. The book also presents more statistical evidence for how widespread mental health problems are among crime victims in the developing world.
The idea that people in the developing world are mentally unaffected by everything from police abuse to unprosecuted rape and murder (when we know that these are traumatizing to people in the developed world) has unfortunate echoes of old racist stereotypes. Nineteenth century explorers were often surprised to see indigenous people crying: whites had assumed that non-white races were more resilient and less emotional. (Think of the “stoic Native American” stereotype.)
Great point about the cross-cultural validity of depression diagnosis.
For that matter, I’d be awfully concerned about the cross-cultural (or cross-socioeconomic-group!) validity of life-satisfaction measures. Often they are asked something like so:
There are obvious ways in which this question might cause someone to give, say, their life satisfaction as a percentile compared to people around them, rather than an absolutely comparable number, which would bias it up a lot for poor countries.
I’m not sure what an absolutely comparable number would be: people would have to be comparing themselves to the same unchanging criteria over time. The evidence, from the Easterlin Paradox etc. is that people do change their standards over time and largely seem work out how they are doing my comparing themselves against others. As such it looks like increasingly worldwide life satisfaction would be very hard.
I take these sorts of argument as reasons to move away from life satisfaction towards direct measures of people’s experience in the moment. I want to know how good or bad the person actually feels, not how well they they are doing against an arbitrary and changing standard.
Just a small note: the book you refer to, “A Plague of Locusts”, is actually called “The Locust Effect” (Haugen and Boutros) - took me a while to find it, so figured that others might appreciate the correction :) Thanks for the recommendation.
I don’t think my own experiences are terribly important and I’m much more interested in arguing about the points themselves.
I’m not sure how you can disagree with the statement that mental health disorders are worse than poverty in terms of happiness; that’s true simply in virtue of what they are. Being depressed means you experience lots of negative mental states (i.e. are unhappy). Being poor doesn’t mean that. Actually being unhappy has to be worse than being a state that is likely to make you unhappy.
Putting this the other way round, you could say “depression is bad for your income, but being in poverty is worse”. Depression might cause you to earn less, but if you’re looking at income, then the state of having a low income has to be worse than having something liable to cause you to have low income. It’s also not true that all people in poverty are depressed. So I think it makes more sense to target misery, not poverty.
Do you think I’ve misunderstood your point? Sorry if I have.
I’m also very much in favour in targeting violence, crime, etc. as those seem obviously bad for happiness. However I’m not sure how bad, nor do I have a potential solution. On that note, the problem of adaptive preferences, as discussed by Sen, etc. is quite interesting. He argues that the poor adapt to their terrible condition and thus they seem surprisingly happy—they are making the best of a bad lot—and that is an additional reason to do something.
I take the other line: if I could save person X who will be made happier, or person Y who won’t be because person Y will adapt to the new condition, I’d want to treat X, not Y.
I feel like this is a motte-bailey argument. Sure, in some trivial sense “depression” is what everyone cares about, in that everyone wants to prevent suffering. A chicken on a factory farm is “depressed”. An acid attack victim is “depressed”. But it seems like when you say depression, what you really mean is “feelings of lethargy, apathy, and discouragement that afflict many people (particularly Westerners) at some point during their lives”—this is what most people understand depression to mean. It’s certainly arguable whether this is worse than many other forms of suffering, and it feels a bit arrogant to glibly dismiss other experiences.
Furthermore, you continue to use “mental health disorder” as synonymous with “depression”. As I asked before, where’s your solution for schizophrenia?
I’m not sure how you’ve reached your conclusion on the basis of what I’ve said. I’m taking ‘depression’ to be a mental health disorder with certain symptoms, including substantially lowered mood. I’m not using ‘depression’ as a synonym for ‘feeling a bit bad’.
I’m making the claim that depression, which is constituted by lots of negative emotional states (i.e. states that feel bad to the person) is probably worse that many, if not all, other forms of suffering in terms of happiness (your ‘happiness’ = the sum total of momentary positive mental states less your negative ones). In part this is because depression induces intense negative states, in part because we don’t seem to be able to hedonically adapt to the condition in a way we can to, say, becoming paraplegic.
I’m not glibly dismissing other cases of suffering. I think you seem to be objecting to doing all things considered evaluations of how bad various things are. If you don’t want to do all things considered evaluations it’s quite hard, if not impossible, to make important moral choices.
Depression is just one of a range of mental health disorders, that’s true. Where I’ve used them synonymously that was simply careless and definitely my mistake.
And I don’t have solution for schizophrenia, nor did I realise I was supposed to! I’m a philosopher who researches happiness, not a psychiatrist.
I think the claim that depression “is probably worse that many, if not all, other forms of suffering in terms of happiness” is far too strong and you haven’t provided sufficient evidence for it. As you said, you’re not a psychiatrist, and I think you’re relying too much on a priori (and somewhat tautological) reasoning, evidence from self-reporting of questionable validity, and outdated research on adaptation (see the meta-analysis that I linked in another comment). There’s a case to be made for your position, but it needs to be strengthened to justify your sweeping statements.
The reason I brought up schizophrenia is because it felt like you were moving the goalposts, not because I expected you to have a solution. You brought up aggregate mental illness statistics but then only discussed depression. But thank you for admitting the mistake.
Just to add to this. Acute schizophrenia is one of the worst health conditions on GBD13 DALY weightings (c.0.8). Severe depression is also one of the worst (c.0.65).
See http://www.thelancet.com/action/showFullTableImage?tableId=tbl2&pii=S2214109X15000698
So Michael—I agree it’s very possible that mental health disorders are underweighted by DALY weightings because of the focusing illusion. But they are actually weighted quite highly at the moment. 10 years with severe depression is worth approximately 3.5 years of healthy life.
yes, it’s interesting that schizophrenia tops the list anyway, although this could be the case in virtue of the face it stops you from leading a normal life part of the disability (this being based on the EQ-5D), rather than because severe schiozophrenics are less happy than severely depressed people.
although they are weighted highly, that doesn’t stop them from being underweighted. Given the way DALYs are constructed—measuring health, not happiness; using preferences, not adaptation—it’s conceptually very hard to see how mental health conditions can’t be underweighted in terms of happiness. Unless and until we measure people’s experiences of various diseases we really won’t know.
My guess is that depression could be the most comparatively underweighted health state: if you can function normally, but you’re just really sad, you might do pretty well on an EQ-5D metric because you’re only doing badly in 1 of 5 criteria, and that’s the criteria most linked to happiness.
As an aside, do you know how the GBD project takes episode duration into account? Or is it just a measure of intensity?
1.5./6.5 = 23% difference. That is statistically significant under any reasonable assumptions.